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The tile floor that was all that remained of the old house and clinic building is still visible in front of the new clinic.

We got to the Cumpio’s place around 4:00 pm, where everything was set up for the ribbon-cutting ceremony and reception. I got a few photos while we still had daylight (sun sets early in the tropics!) and then we hung out on the beach while waiting for the festivities to start. (Naomi swam again.)

This photo is from April. The white tiles under the cement blocks are the same ones in the photo above of the completed clinic in September.

As the rebuilding project picked up steam, more people became involved: last month, a new grant was secured to help finish the inside of the building so that it could pass the health department inspection, and an ambulance vehicle was donated as well. This was truly the work of many hands and hearts.

With Nerissa beside one of several signs erected for the opening, thanking the many donors who helped in the rebuilding.

Looking around the clean, bright, spacious clinic building, I couldn’t help but remember the many nights Nerissa and I had spent attending births together in a hot, stuffy tent. What a contrast! What a significant step, not just for the Cumpio family but for the whole community, in recovery, rebuilding, and restoring local capacity! The first baby expected to be born in the new clinic is due this last week of September, with many more to come thereafter.

Ribbon across the front door all ready to go!

By the time the celebration began, it was too dark to get good photographs. My heart was so full, it was hard to imagine how much more momentous this occasion must be for the Cumpio family. Lots of tears through the smiles. It is impossible to forget the loss and devastation that preceded this event, the lives that were shattered by Yolanda. I am in awe of the resilience and strength of the people of Leyte and so very, very blessed to be able to count Nerissa as a friend and colleague.

Trying to put my heart into words.

Having learned our lesson on Monday, we left the party before it was really over to start driving back to San Ricardo ferry. I needed to be back in Davao on Thursday and could not afford to spend all day Wednesday waiting at the ferry terminal. So much for my original plan to avoid night driving! We arrived safely to the port a little after 1 am and were told that the scheduled 3 am sailing was full already but that we would be on the next boat at 8 am. Grabbed a few hours sleep in the car. The “8 am” boat finally left, with us on board, around 11:30, and we were home by 10 pm on Wednesday night. I’m already scheming about another visit, with a less tight timeline, when Matt and the kids have a school break. To quote the t-shirt depicting the MacArthur Landing Memorial which I brought home for Ezekiel, “Once you see Leyte, you will return!”

We’ve been a bit remiss in blogging, though there’s been plenty of action on our Facebook page. Here, I’ll just share some photos from the last month.

Here are some buntis (expecting mothers) gathered for the clinic’s prenatal outreach to the Badjao community in Isla Verde:

Naomi came along with Sora, the better to see babies. She is wearing her colorful “Badjao pants” in an effort to fit in.

The results of the fire several weeks ago can still be seen near in the blacked sticks protruding from the water – the remains of bamboo houses that burned to the waterline. This photo was taken from the roof of the new medical clinic building where the prenatal outreach is also held.

Of all the Filipina midwives I worked with in Dulag, Maricel was one of the hardest to get to know. I saw quickly that she was extremely hardworking and responsible as well as being one of the most knowledgeable and experienced midwives on our team, but she was shy and a little mistrustful of foreigners. After several weeks of working together, she opened up and I learned more about her family and her experiences during the disaster. Like the other residents of coastal Leyte, which is no stranger to typhoons, Maricel was taken by surprise by the force of Yolanda. (Back in November, Philippine president Aquino told reporters “nobody imagined the magnitude that this super typhoon brought on us” and this was certainly true of everyone I spoke to.) Maricel, her husband and her daughters were in Dulag when Yolanda made landfall but her teenaged son, who attends school an hour away in Tacloban, was not with them. Communications were cut off after the storm and the roads were impassable. It would be more than a week before the separated members of the family knew that all had survived. Maricel and her family were among the fortunate: there were no fatalities in the immediate family and they lived far enough inland that they did not lose everything they owned. Even so, picking up the pieces and putting their lives back together was a daunting and difficult task.

The “birth camp” where I volunteered was funded and directed by outside (foreign) donors. In the immediate aftermath of supertyphoon Yolanda, numerous NGOs came to provide temporary health care services in the affected areas, and these services were desperately needed. The local clinics and hospitals had been damaged or destroyed, medical supplies and equipment were washed away, and the local doctors, nurses, and midwives were themselves typhoon survivors who had lost homes, possessions, and family members. However, foreign assistance for necessary health care is a temporary, immediate-post-disaster-relief strategy that becomes much less appropriate in the recovery and rebuilding phase. Restoring locally directed health care services is necessary for a community to return to normal.

During my time in Leyte, I saw firsthand some of the detrimental unintended consequences of having foreigners providing (free) health care. Prior to typhoon Yolanda, every barangay (village or district) had a Rural Health Unit providing midwifery care for low-risk births as well as other health care (each RHU also had an ambulance for transport to a higher level facility (hospital) when needed). In most barangays, there were also several privately owned “lying-in clinics” (birth centers) accredited by PhilHealth, the national health care plan. In the aftermath of the disaster, the Philippine government adopted an “all-avail PhilHealth” policy for citizens affected by typhoon Yolanda. This meant that everyone in the disaster area was eligible to receive PhilHealth coverage for needed services, regardless of whether they had previously paid the premiums normally required for coverage. Prenatal care, birth, and postpartum and newborn care at any PhilHealth accredited facility (either a hospital or lying-in clinic) was among the covered services.

Because our organization gave out “freebies” to patients both at prenatal checkups and when they gave birth (food and vitamin supplements, baby clothes and blankets, tarps), patients came to us to get prenatal care and give birth in our tent-clinic even when they had to pass multiple functioning birth centers on the way to our facility. In fact, on more than one occasion pregnant women arrived who had traveled up to two hours or even more, sometimes from areas that were not even affected by the typhoon. Midwives who had run privately-owned PhilHealth accredited birth centers in the area prior to Yolanda were losing patients and income because their patients were coming to us. In some cases, the patients were not aware of the PhilHealth “all-avail” policy and believed they would have to pay for care at the local clinics; in other cases, they just didn’t want to miss out on the “freebies” that we were giving away.

Maricel’s clinic building after the typhoon. The clinic is on the first floor; the second story was where her family lived. They are now living in the kitchen area behind the clinic. In addition to the wall and roof damage, their water-pressure tank was destroyed when a neighbor’s wall collapsed.

Maricel, owned her own birth center in another barangay of Dulag about 20 minutes away. Maricel’s clinic was still open for business despite the building having sustained significant damage from Yolanda. She came to work for the birth camp in San Jose school because “all her patients were coming here” and without patients she had no income to pay for the operating costs of her own birth center (professional fees, business license, etc.)

Maricel’s youngest daughter “out back” at the laundry/kitchen area behind her clinic.

After discussing the issue with the project manager for the birth camp, we encouraged Maricel to talk to patients from her barangay who came for prenatal care at the birth camp, making sure that they knew her clinic was open and that care there was free under the “all-avail PhilHealth” policy, and encouraging them to transfer their care to her much closer birth center. Before Yolanda, Maricel’s clinic had usually had 8-10 births every month. She had had only four deliveries total during the first three months of 2014, but after she started “recruiting” patients from the birth camp, there were four births at her birth center in the first two weeks of April (before I returned to Davao… hopefully there have been more by now!) She is hoping to continue to increase her patient load to the point that she can stop working at the birth camp and focus on her own clinic.

Maricel with a new mother at her clinic.

When I visited Maricel’s clinic I was impressed at how clean, organized and inviting it was despite the typhoon damage. She had obviously worked very hard to keep her clinic open and functional after losing the top half of her building (which served as her family’s living quarters.) However, every time it rained water would leak from the roofless second story into the clinic in numerous places, requiring buckets in the hallway and causing significant ceiling damage.

Water damage and mold on the ceiling of the delivery room in Maricel’s clinic.

The estimated cost to repair the roof and damaged second-story walls and replace the water-pressure tank is a little over $2000 USD. Maricel has struggled to keep her clinic open since typhoon Yolanda and coming up with the funds for the repairs is completely beyond her family’s means. Aside from the ongoing damage to the clinic ceiling every time it rains and the loss of the family’s living space, the obvious damage to the outside of the building has been a deterrent to potential patients who were not aware the clinic was still open. (Maricel’s husband has since erected a large sign making clear that the clinic is open for business and also advising residents that they can get free care at the clinic due to the “all-avail PhilHealth” policy.)

With Maricel outside her clinic building.

Contributing to the repair of Maricel’s clinic will both directly help a family return to an independent livelihood after typhoon Yolanda and also ensure ongoing maternal-child health services in a low-resource area of rural Leyte. To give online, click this link and select “Special Project.” 100% of donations received will go toward either Maricel’s clinic repair or to the second clinic repair project (Cumpio clinic in Tanuan, Leyte) which I will post about shortly. I intend to post “after pictures” of the clinic when repairs have been completed.

It’s been difficult to know how to begin to write about the month I spent volunteering at a makeshift birth center in the town of Dulag on the island of Leyte, ground zero for last November’s super-typhoon Yolanda (Haiyan). This first post will be a sort of introduction / overview and I’ll write later, in more detail and with more pictures, about specific events and people.

I’ve now heard many first-person accounts from survivors and relief workers who were there in the early weeks after the disaster. I’ve seen many photos and videos of the immediate aftermath. But it is still difficult for me to wrap my mind around the sheer scale of the devastation. By the time I arrived in Tacloban airport on March 15, more than four months after Yolanda, recovery and rebuilding was well underway. Evidence of the typhoon’s damage was everywhere, events were referred to as “before Yolanda” or “after Yolanda” and many people were still living in donated tents or under tarps with the donor organization’s name emblazoned in large letters. But the area had clearly settled into a “new normal.” New construction here and there denoted those who could afford to rebuild. A brisk new trade in the manufacture and sale of concrete blocks and the recycling of bent and damaged metal roofing was evident. Roadside stands offered an ever-increasing variety of produce, heaps of sprouted coconuts waiting to be planted to replace the thousands of lost trees could be seen by the roadsides, and some of the gardens that had been replanted “after Yolanda” were ready for harvest.

Many plants grow incredibly quickly in the tropics, but the coconut trees will take many years to replace.

The town of Dulag is about an hour’s drive south of Tacloban, down the eastern coast of Leyte island. It was in the “eye of the storm” and while the incredible winds of the strongest typhoon to make landfall in recorded history did a lot of damage, Dulag did not experience the same devastating storm surge that caused thousands of fatalities in Palo, Tanuan, and Tacloban itself. The big wave (higher than the coconut trees, according to witnesses) went north up the coast rather than directly inland.

The clinic where I was volunteering was set up in early December. Tents were erected inside the large assembly room of a local elementary school because the building had lost its roof and a solar suitcase was used for lighting. By the time I arrived, we had electricity and the roof had been repaired, but we were still using tents because they were convenient room dividers and allowed a semblance of privacy. The volunteers slept in tents at one end of the long hall. There was a tent for medical supplies, a tent with two beds in it that served as the “delivery room”, and an L-shaped three-room tent with cots in it for mothers and babies to stay postpartum. If we had more patients than room in the tents, we set up extra cots for them wherever we could.

School canteen, battered by Yolanda and no longer in use.

Another damaged school building, looking out from the clinic toward the highway. The ocean is barely visible between the buildings and broken coconut palms.

In addition to volunteers from the US, New Zealand, and Europe, we had a great team of Filipino staff: six lovely midwives, a nurse who ran a sort of “urgent-care clinic” six mornings a week out of a Unicef tent set up outside next to the school playground, administration and support staff who took very good care of us. Most of these (except for the project manager) were local residents. The school building is right off the Pan-Philippine highway (more of a quiet country road at that point) and the beach is just across the road.

The Filipina midwives pose in our prenatal area (behind them is the tent for postpartum patients.)

School in the Philippines runs from June through March; April and May are the summer vacation months. So when I arrived San Jose Central school was still in session. The school administration was incredibly gracious about having a full-scale birth center on the premises and the children were charming, friendly, and extremely interested in us, peeking at us through the windows and doors from early in the morning until late in the evening. Despite the extreme damage to the school building and the surrounding community, there had been no fatalities in the student population during the typhoon (largely because the barangay of San Jose had been spared the deadly storm surge) and the students ended their year on time, having only missed a few days of school because of Yolanda.

In the doorway are Soichi and Tricia, two of our little friends whom we saw almost every day.

During some of my free-time while in Dulag, I reread When Helping Hurts (kindle edition on my phone) and sadly I saw more than one real life violation of the principles of “helping without hurting.” Immediate disaster relief work is stressful, intense, and difficult. Navigating the transition from relief to rebuilding is complex, challenging, and fraught with opportunities for unintended consequences. I learned a lot during my time in Leyte. While preparing for my trip, I solicited donations to help with buying supplies for the birth center where I would be working, and was able to use these to fill a suitcase, out of which much (especially baby hats and blankets) was distributed to the families of some of the 87 babies born while I was there. I quickly became convinced that, helpful as it was to the families we were caring for to have a place to come for a safe, gentle birth, it was more important for the community as a whole to work on restoring the health care infrastructure that had existed before the typhoon … and that our very presence as foreigners, giving away “freebies”, in many ways created a disincentive for that to happen. I realized that in order to make the greatest positive impact during my time in Leyte, my focus needed to be on supporting and assisting the local midwives I was working with in any way I could.

On Friday, our family prayed together, then the kids and I laid hands on Sora and asked the Lord to watch over her and bless her work. Krys M., the director of the birth clinic here in Davao then drove Sora to the airport. She went first to Manila, where she stayed overnight because weather had delayed her flight. Then on Saturday, she boarded a plane to Tacloban, the capital of the province of Leyte. From there, she got a ride to Dulag, a smaller town where she will be working with a team of Filipina and international midwives in a field birth clinic. It is situated in a school building that was de-roofed by the super typhoon last year; though the building now has some roofing, the clinic is still in tents. There are 6 Filipina midwives and international volunteers, including a midwife from Poland and one from New Zealand.

Sora texted me that traces of the typhoon’s devastation are still everywhere. She also said that she has no internet (expected), and that her cell phone only has reception in a certain 3-foot square. We texted for a while in that spot, but I’m not expecting further regular communications.

Instead, Sora will be writing in a paper notebook with a pen and taking photos with her phone, and she will blog about the four weeks when she returns. If she texts me anything further before then, I’ll of course post it.

Some days here can be challenging, frustrating even. The days you wake up with no power and no running water. The days your patient tells you she only took 3 doses of the antibiotic that was prescribed for 10 days because she couldn’t afford to buy more (yes, most medications here really are sold in single pill units.) The days you spend hours waiting in line and still haven’t managed to get all the required paperwork completed. But to make up for it, there are also days when I can hardly believe how lucky I am to get to live here and do the work I do.

Today I supervised swing shift at the birth center (2 pm – 10 pm.) As a supervisor I have more responsibilities and less time for direct, hands-on patient care but I get to do a lot more teaching, which I really enjoy. Seeing your student do something well is even more satisfying than doing it well yourself.

The shift started slowly: it had been a quiet morning without any births, and there was only one patient admitted, in labor with her second baby. Over the course of the afternoon, a few mothers brought their newborns in for scheduled check-ups. Most of these were uneventful — healthy mothers and healthy babies — but just before 4 pm a young couple came in with their new baby whose newborn screening test had just come back positive for G6PD deficiency. This metabolic disorder is not uncommon here and means that the baby lacks the enzyme glucose-6-phosphate dehydrogenase, and exposure to certain foods or medications may lead to hemolysis (destruction of red blood cells.) We spent a lot of time educating the parents about how to protect their baby and referred them for confirmatory testing.

As we were finishing up with this, another woman in labor walked into the birth room. She flashed me a big smile of recognition: I had been her midwife for her prenatal check-up earlier in the week. Her two adorable older boys peeked through the window from the waiting area outside. As J, one of our younger Filipina staff midwives, started checking the baby’s heart tones and the mother’s vital signs, we pulled out her chart and realized there was a problem: the baby was not due for another month. We try to avoid premature births at our clinic: as a birth center, we have everything necessary for normal births and full-term babies but we are really not equipped to provide respiratory support to babies whose lungs are not mature. We started to prepare for transport to the hospital but quickly realized there was not going to be time for that as her water broke and …ready or not, here comes baby! I made a snap decision that a late preterm baby here at the clinic was preferable to a late preterm baby in the ambulance van and we quickly got ready for the birth. A few minutes later a screaming baby boy was on mama’s chest and I was breathing a sigh of relief as I listened to him voice his annoyance with his untimely eviction: no resuscitation needed this time. At 2000 grams (4.4 lb) this little peanut was only half the size his next oldest brother had been at birth! He struggled a little with transitioning to using lungs that would really have benefited from a few more weeks inside, and there were a few moments when I thought we’d be sending him off to the hospital after all, but thankfully kangaroo care and close monitoring turned out to be all that was needed.

Once baby was stable the next step was sewing up his mama’s tear from the very speedy delivery. J needed a little help with her suturing technique — in fact, I had to tell her to pull out her first stitches and do them over again. I was proud of her for trying again instead of taking the easy way out and just having me do the repair, and by the time she finished she was proud of herself for a job well done and felt like she had really learned a lot.

By now the mother in the next bed was ready to push, so I left J to continue her postpartum watch and stepped over to the other side of the curtain to supervise the birth of another baby boy, a chunker by comparison at a week past his due date. He lost no time getting down to business with his new full-time jobs of eating and pooping.

At the same time that all of this was happening, one of the other midwives had been giving me regular updates about the young (teenaged) first time mother who had come in in very early labor shortly after our first birth of the shift. She was only 2 cm dilated and not having very strong contractions yet. Normally this would mean we would encourage her, explain the signs of active labor, and send her home. Unfortunately, this mother’s blood pressure was elevated — not to the point where we needed to transport to the hospital, but too high for us to just send her home. First, we instructed her to drink water and lie on her left side for a while, which often will normalize blood pressure — unfortunately, hers was actually a little higher when we checked it again. On hearing this, she started to cry and said she really did not want to go to the hospital. (Unlike our birth center, the hospital does not allow family members in the labor and delivery rooms and her mother who was doing a great job of supporting her would not be able to stay with her if she was transported.) I had her midwife quickly test for protein in her urine — all clear — and start an IV of D5W hoping to get her blood pressure to stabilize and buy her enough time to possibly be able to still deliver at the birth center. It worked — her blood pressure came back down to a more reasonable level — and she settled in to rest before labor really kicked in.

Our final patient of the night came in a little after 8:00. She was also a young first time mother, and also was not quite in active labor yet. Since there were no concerns about either her or the baby she was told to go home, eat dinner, and rest and instructed about when to return to the birth center. Later, the midwife who had checked her and sent her home was helping to clean up the birth room after our two patients who had given birth had moved to the postpartum area. She carried one of the big plastic trash cans we use for soiled linens out to the laundry area which is outside the clinic, behind the entrance hallway and family waiting area. She came back in laughing: “Remember the patient I sent home an hour and a half ago? I just found her hiding in the laundry area.” Like so many other first-time mothers, she was quite certain that her labor would be the exception to the norm and was deeply concerned that her baby would accidentally be born at home or in a taxi if she did not stay very close to the birth center! (While amused by this, I am also deeply sympathetic: when I had my first baby I was told “you’re not really in labor yet, go home” for three consecutive nights of non-stop contractions in a row until in desperation and exhaustion I finally dug in my heels and refused to leave the birth center.)

After giving report to the night shift team we all prayed together — for safety and normal, progressive labors for our two young mothers (the one with high blood pressure and the one who wouldn’t go home), for continued health and well-being for our little premie who was still struggling with breastfeeding, and with great thanksgiving for God’s mercies to us. Such a fun shift with a great team of midwives. I love my job.

On March 14th, Sora will be traveling to Leyte Island. She’ll be volunteering at a “field clinic” in the town of Dulag, 30 km south of Tacloban. Last November’s super-typhoon destroyed 80% of homes in the community and hospitals and health centers still need to be rebuilt. Most midwives, doctors and health care workers in the community lost their homes as well. Sora will spend four weeks working with local Filipina midwives and with 2011 CNN hero of the year Ibu Robin Lim who is running the birth camp. Robin Lim has previously been on the scene to provide maternity care in post-disaster situations in Aceh, Indonesia after the 2004 tsunami and in Haiti after the 2010 earthquake. Births at the Dulag “Birth Camp” clinic take place in tents and supplies are still very limited. Sora will be bringing a suitcase of much-needed medical supplies with her when she goes.

If you are interested in helping to fund the purchase of supplies for the Birth Camp, you can send a check to SAMS, PO Box 399 Ambridge, PA 15003, with “Colvin special project” in the memo line, or choose “special project” on our online giving page. 100% of your donation will be used for purchasing supplies and Sora will be hand-delivering them.